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1 Employment Application WE ARE AN EQUAL OPPORTUNITY EMPLOYER: We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other legally protected class by local, state or federal law. Parks Youth Ranch., Inc. seeks a workforce of talented and committed professionals who wish to be instrumental in our mission of providing emergency shelter, counseling and life changing skills to atrisk and homeless youth. PLEASE PRINT IN INK Personal Information Last Name: First Name: Middle Name: Address: Phone Mobile number: number: address: Job Related Information Position Applied For: Salary Expectations: $ Date of Application: How did you learn about Parks Youth Ranch? Newspaper: PYR Website Careerbuilder Monster College Website: NACSW Yahoo! HotJobs Work in Texas Employee Referral: Employment Agency Walk-in Job Fair Other: Are you legally eligible to work in the United States? Proof of eligibility status will be required upon employment. Are you over the age of 21 years? If not, give your birth date? Have you ever filed an application with us before? If yes, give date Have you ever been employed by us before? If yes, give date Do you have a valid driver s license? Are you related to anyone employed by Parks Youth Ranch, Inc? If yes, what is their name and relationship to you? Are you currently employed? May we contact your present employer? Have you ever been fired or asked to resign from a job? Can you travel if your job requires it? Have you ever been convicted or pleaded nolo contendere to a felony or misdemeanor charge? If yes, please explain. Conviction will not necessarily disqualify an applicant from employment. Have you ever been indicated or founded on a child abuse charge? If yes, please explain. 1

2 On what date would you be available to begin work? Availability for Work Are you available to work? Full time Part time Shift Work Temporary Days and Hours Available: High School Undergraduate College Graduate/Professional Other (Specify) Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday AM PM Education Name and Location of School Course of Study or Major Certification/Licensure Please list any current licenses or certificates that are relevant: # of Years Completed Diploma/Degree Awarded? 1) 2) 3) Indicate any foreign languages you can speak, read and/or write. Speak Read Write Fluent Good Fair Fluent Good Fair Fluent Good Fair Fluent Good Fair Fluent Good Fair Fluent Good Fair Fluent Good Fair Fluent Good Fair Fluent Good Fair Describe any specialized training, apprenticeship, skills, extra-curricular activities or special job-related skills. Describe any job-related training received in the United States Military. Describe any additional information that you would like to include (i.e. personal testimony, personal mission, etc.) 2

3 Employment History Start with your current or most recent job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Do not exclude any employment. Please attach resume; however you must still complete all employment questions which are asked below. Company Name: Address: Telephone Number(s): Job Title: Work Performed: Supervisor: Dates Employed: Hourly Rate/Salary: From Starting $ To Final $ Reason for Leaving: Company Name: Address: Telephone Number(s): Job Title: Work Performed: Supervisor: Dates Employed: Hourly Rate/Salary: From Starting $ To Final $ Reason for Leaving: Company Name: Address: Telephone Number(s): Job Title: Work Performed: Supervisor: Dates Employed: Hourly Rate/Salary: From Starting $ To Final $ Reason for Leaving: 3

4 Professional References Name Address Phone Number Relationship/ Occupation Years Known 1) 2) 3) Personal references that speak to your character Name Address Phone Number Relationship/ Occupation Years Known 1) 2) 3) 4

5 Applicant s Statement *Please read carefully before signing* I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances or discovery. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended to me by Parks Youth Ranch, Inc. (herein referred to as PYR ) that such employment with PYR is at will, for no specific duration, and may be terminated by either PYR or myself. I understand that none of the documents, policies, procedures, actions, statements of PYR or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representatives of Parks Youth Ranch, Inc. has the authority to enter in to any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements. In consideration of employment with PYR, if employed, I agree to conform to the rules, regulations, policies and procedures of PYR at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Parks Youth Ranch s business, attendance and punctuality are considered essential requirements of every job at PYR and that poor attendance or tardiness will result in disciplinary action. I understand that if offered a position at PYR, I may be required to submit to a pre-employment medical examination, drug screening, and background check as a condition of employment. I understand that any unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks, either through intentional or negligent actions, will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to PYR and/or any of its representatives, and I release all parties involved from any and all liability for any and all damage that may result from providing such information. I understand that this application is considered current for six months. If I wish to be considered for employment after this period, I must fill out and submit a new application. BY SIGNING BELOW I ACKWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS. Applicant s Signature Name and number of person completing this application if other than applicant: Revised 02/01/2013 Date 5

6 Parks Youth Ranch Mission Statement To provide emergency shelter, counseling and life changing services to at risk and homeless youth. Parks Youth Ranch Vision Statement Through strong and effective community partnerships with a sustainable financial base, the youth receiving treatment at the Fred and Mabel R. Parks Youth Ranch will be empowered with coping skills, hope and achievable goals and no longer at risk of being homeless. Parks Youth Ranch Core Values All children deserve a permanent, safe and emotionally healthy place to live. We believe in the inherent potential that exists in each child, no matter what their circumstances. Through our community partnerships, we have the skills and knowledge to develop youth and family services that provide life-changing results. Services offered at the ranch are provided in a respectful, consistent and effective manner where the child s needs are the central focus no more square pegs in round holes. Investing in children offers long-term benefits affecting not only the individual, but society at large. PYR will be an efficient and effective steward of our resources to support at-risk children. I have read and understand the Core Value, Mission Statement, and Vision Statement of Parks Youth Ranch, Inc. Signature Date 6